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Dane County Land Conservation Division <br /> DINAP - "Do I NEED A PERMIT" <br /> General Information: <br /> Caller/Contact: Jeremy Van Horn <br /> Phone#: (608) 712-5877 <br /> Landowner: same Phone#: same <br /> Contact email: JVHorn @tds.net <br /> Project Address: 11088 Randolph Ct <br /> Location:Township: Black Earth Sec: 19 1/4 NW <br /> Parcel#: 0806-192-8670-5 <br /> Project Description: Addition to House, referred from zoning because it is on >12% slopes <br /> Planned Size of Disturbance: <br /> Planned Size of New Impervious: ft2 <br /> Land Conservation Division Response :' <br /> Based on information above the project: DOES* <br /> O OES NOT require a permit <br /> Determination Made By: DJAH DJAS ❑ <br /> JDB DJRT DRLS AJM <br /> *Type of permit required: DEC DES DSM USE ❑SS <br /> ❑Disturbance >4000 ft2 <br /> ✓Slopes> 12% DExcavate/Fill>400 yds3 <br /> ['Disturbing 100' of ditch/channel 0125'New road/driveway EShoreland Zone disturbance <br /> ❑Addition of 20,000 ft2 New Imp. Subdivision Plat/CSM DOther: <br /> Basis for Determination: Only grading lis structural to the new home and covered by UDC. <br /> It is not in the Shoreland Zone. <br /> Permit determination based upon information provided by caller/landowner. Changes in project size,scope or <br /> location may trigger changes to permit requirements. It is the responsibility of the owner to ensure all required <br /> permits have been obtained prior to commencing work. <br />